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New Zealand and Australian governments rely heavily on voluntary industry initiatives to improve population nutrition, such as voluntary front-of-pack nutrition labelling (Health Star Rating [HSR]), industry-led food advertising standards, and optional food reformulation programmes. Research in both countries has shown that food companies vary considerably in their policies and practices on nutrition(1). We aimed to determine if a tailored nutrition support programme for food companies improved their nutrition policies and practices compared with control companies who were not offered the programme. REFORM was a 24-month, two-country, cluster-randomised controlled trial. 132 major packaged food/drink manufacturers (n=96) and fast-food companies (n=36) were randomly assigned (2:1 ratio) to receive a 12-month tailored support programme or to the control group (no intervention). The intervention group was offered a programme designed and delivered by public health academics comprising regular meetings, tailored company reports, and recommendations and resources to improve product composition (e.g., reducing nutrients of concern through reformulation), nutrition labelling (e.g., adoption of HSR labels), marketing to children (reducing the exposure of children to unhealthy products and brands) and improved nutrition policy and corporate sustainability reporting. The primary outcome was the nutrient profile (measured using HSR) of company food and drink products at 24 months. Secondary outcomes were the nutrient content (energy, sodium, total sugar, and saturated fat) of company products, display of HSR labels on packaged products, company nutrition-related policies and commitments, and engagement with the intervention. Eighty-eight eligible intervention companies (9,235 products at baseline) were invited to participate, of whom 21 accepted and were enrolled in the REFORM programme (delivered between September 2021 and December 2022). Forty-four companies (3,551 products at baseline) were randomised to the control arm. At 24 months, the model-adjusted mean HSR of intervention company products was 2.58 compared to 2.68 for control companies, with no significant difference between groups (mean difference -0.10, 95% CI -0.40 to 0.21, p-value 0.53). A per protocol analysis of intervention companies who enrolled in the programme compared to control companies with no major protocol violation also found no significant difference (2.93 vs 2.64, mean difference 0.29, 95% CI -0.13 to 0.72, p-value 0.18). We found no significant differences between the intervention and control groups in any secondary outcome, except in total sugar (g/100g) where the sugar content of intervention company products was higher than that of control companies (12.32 vs 6.98, mean difference 5.34, 95% CI 1.73 to 8.96, p-value 0.004). The per-protocol analysis for sugar did not show a significant difference (10.47 vs 7.44, mean difference 3.03, 95% CI -0.48 to 6.53, p-value 0.09).In conclusion, a 12-month tailored nutrition support for food companies did not improve the nutrient profile of company products.
Alcohol use disorder is a global public health concern and national policies are often implemented to help control alcohol consumption and related consequences. Increasingly, many countries are resorting to transient (short-term) alcohol policies which are implemented for a restricted period of time as an action plan for particular events or health-related issues. The COVID-19 pandemic emphasised the need for rapid decision-making and short-term fast-acting policies. This paper discusses contexts in which these transient policies are used and highlights the need for impact measurement and global exchange of experiences. This is particularly important to avoid gaps that the global alcohol industry could utilise to expand its influence and market.
Microplastic pollution from plastic fragments accumulating in agricultural fields threatens the world’s most productive soils and environmental sustainability. This is the first paper to address the challenge of developing a dynamic economic model to analyze the adoption of soil-biodegradable plastic mulches (BDMs) as a sustainable alternative to conventional polyethylene mulches. The model considers the trade-off between BDM degradation rates and agricultural production, seeking to balance the cost of BDMs and the cost of waste disposal. We consider both private and social perspectives under deterministic and stochastic environments. Our findings suggest that BDMs can significantly decrease long-term plastic pollution from single-use plastics in agriculture. For example, increasing landfill tipping fees incentivizes Washington State tomato growers to optimally adopt BDMs with a 61% degradation rate and to till used BDMs into the soil, reducing plastic waste accumulation in landfills. The study highlights the role of economic incentives, such as landfill fees, corrective taxes and the role of risk aversion, in promoting BDM adoption and curbing plastic pollution. The framework presented here offers valuable insights for policymakers and stakeholders seeking to foster sustainable agricultural practices and mitigate global plastic pollution.
Temporary changes in biological state, such as hunger, can impact decision making differently for men and women. Food scarcity is correlated with a host of negative economic outcomes. Two explanations for this correlation are that hunger affects economic preferences directly or that hunger creates a mindset that focuses on scarcity management to the detriment of other decisions. To test these predictions, we conduct a lab-in-the-field experiment in a health screening clinic in Shanghai, recruiting participants who finish their annual physical exam either before or after they have eaten breakfast. We compare the hungry and sated groups on their risk, time and generosity preferences as well as their cognitive performance. Our results show that men and women respond to hunger in opposite directions, thus hunger reduces the gender gap in decision quality, risk aversion and cognitive performance, but creates one in generosity. Finally, we examine several biomarkers and find that higher blood lipid levels are correlated with greater choice inconsistency, risk aversion and generosity. We contribute to emerging insights on the biological foundations for economic preferences and outcomes.
Studies have shown an association between workplace safety climate scores and patient outcomes. This study aimed to investigate (1) performance of the hospital safety climate scale that was adapted to assess acute respiratory illness safety climate, (2) factors associated with safety climate scores, and (3) whether the safety scores were associated with following recommended droplet and contact precautions.
Methods:
A survey of Canadian healthcare personnel participating in a cohort study of influenza during the 2010/2011–2013/2014 winter seasons. Factor analysis and structural equation modeling were used for analyses.
Results:
Of the 1359 participants eligible for inclusion, 88% were female and 52% were nurses. The adapted items loaded to the same factors as the original scale. Personnel working on higher risk wards, nurses, and younger staff rated their hospital’s safety climate lower than other staff. Following guidelines for droplet and contact precautions was positively associated with ratings of management support and absence of job hindrances.
Conclusion:
The adapted tool can be used to assess hospital safety climates regarding respiratory pathogens. Management support and the absence of job hindrances are associated with hospital staff’s propensity and ability to follow precautions against the transmission of respiratory illnesses.
The relationship between spirituality and behavioural addictions is complex. Although some studies have suggested spirituality to be a protective factor helping in recovery from addictive behaviours, others have found spirituality to be a potential risk factor. To better understand the relationship between spirituality and various behavioural addictions, this review summarises the literature on the association between spirituality and the following behavioural addictions: gaming disorder, gambling disorder, problematic internet use, problematic smartphone use, compulsive sexual behaviour disorder and compulsive buying/shopping disorder. Implications for clinical practice and future research are discussed.
Unhealthy food environments are major drivers of obesity and diet-related diseases(1). Improving the healthiness of food environments requires a widespread organised response from governments, civil society, and industry(2). However, current actions often rely on voluntary participation by industry, such as opt-in nutrition labelling schemes, school/workplace food guidelines, and food reformulation programmes. The aim of the REFORM study is to determine the effects of the provision of tailored support to companies on their nutrition-related policies and practices, compared to food companies that are not offered the programme (the control). REFORM is a two-country, parallel cluster randomised controlled trial. 150 food companies were randomly assigned (2:1 ratio) to receive either a tailored support intervention programme or no intervention. Randomisation was stratified by country (Australia, New Zealand), industry sector (fast food, other packaged food/beverage companies), and company size. The primary outcome is the nutrient profile (measured using Health Star Rating [HSR]) of foods and drinks produced by participating companies at 24 months post-baseline. Secondary outcomes include company nutrition policies and commitments, the nutrient content (sodium, sugar, saturated fat) of products produced by participating companies, display of HSR labels, and engagement with the intervention. Eighty-three eligible intervention companies were invited to take part in the REFORM programme and 21 (25%) accepted and were enrolled. Over 100 meetings were held with company representatives between September 2021 and December 2022. Resources and tailored reports were developed for 6 touchpoints covering product composition and benchmarking, nutrition labelling, consumer insights, nutrition policies, and incentives for companies to act on nutrition. Detailed information on programme resources and preliminary 12-month findings will be presented at the conference. The REFORM programme will assess if provision of tailored support to companies on their nutrition-related policies and practices incentivises the food industry to improve their nutrition policies and actions.
Patients with ventricular assist devices (VADs) represent a growing population presenting to Emergency Medical Services (EMS), but little is known about their prehospital care. This study aimed to characterize current EMS protocols in the United States for patients with VADs.
Methods:
States with state-wide EMS protocols were included. Protocols were obtained from the state EMS website. If not available, the office of the state medical director was contacted. For each state, protocols were analyzed for patient and VAD assessment and treatment variables.
Results:
Of 32 states with state-wide EMS protocols, 21 had VAD-specific protocols. With 17 (81%) states noting a pulse may not be palpable, protocols recommended assessing alternate measures of perfusion and mean arterial pressure (MAP; 15 [71%]). Assessment of VAD was advised through listening for pump hum (20 [95%]) and alarms (20 [95%]) and checking the power supply (15 [71%]). For treatment, EMS prehospital consultation was required to begin chest compression in three (14%) states, and mechanical (device) chest compressions were not permitted in two (10%) states. Contact information for VAD coordinator was listed in a minority of five (24%) states. Transport of VAD equipment/backup bag was advised in 18 (86%) states.
Discussion:
This national analysis of EMS protocols found VAD-specific EMS protocols are not universally adopted in the United States and are variable when implemented, highlighting a need for VAD teams to partner with EMS agencies to inform standardized protocols that optimize these patients’ care.
The heating rate of plasma electrons induced by external fields or other processes can be used as an experimental tool to measure fundamental plasma properties such as electrical conductivity or electron–ion collision rates. We have developed a technique that can measure electron heating rates in ultracold neutral plasmas (UNPs) with $\sim 10\,\%$ precision while simultaneously referencing the measurement to a calibrated amount of heating. This technique uses a sequence of applied electric fields in four sections: to control the ratio of electrons to ions in the UNP; to provide a time for the application of fields that cause electron heating and subsequent thermalization of the electrons after the application of those fields; to extract electrons from the UNP using a method sensitive to electron temperature that allows the measurement of electron heating; and to extract the remaining electrons to measure the total electron (and therefore ion) number. The primary signal used to measure the heating rate is the measurement of the number of electrons that escape in the third section of the experiment as a larger number of escaping electrons indicates a larger amount of heating. We illustrate the use of this technique by measuring electron heating caused by high-frequency radiofrequency (RF) fields. In addition to the main technique, several subtechniques to calibrate the electron temperature, electron density, amount of heating and applied RF field amplitude were developed as well.
Grain-cooking traditions in Neolithic China have been characterised as a ‘wet’ cuisine based on the boiling and steaming of sticky varieties of cereal. One of these, broomcorn millet, was one of the earliest Chinese crops to move westward into Central Asia and beyond, into regions where grains were typically prepared by grinding and baking. Here, the authors present the genotypes and reconstructed phenotypes of 13 desiccated broomcorn millet samples from Xinjiang (1700 BC–AD 700). The absence in this area of sticky-starch millet and vessels for boiling and steaming suggests that, as they moved west, East Asian cereal crops were decoupled from traditional cooking practices and were incorporated into local cuisines.
The target backsheath field acceleration mechanism is one of the main mechanisms of laser-driven proton acceleration (LDPA) and strongly depends on the comprehensive performance of the ultrashort ultra-intense lasers used as the driving sources. The successful use of the SG-II Peta-watt (SG-II PW) laser facility for LDPA and its applications in radiographic diagnoses have been manifested by the good performance of the SG-II PW facility. Recently, the SG-II PW laser facility has undergone extensive maintenance and a comprehensive technical upgrade in terms of the seed source, laser contrast and terminal focus. LDPA experiments were performed using the maintained SG-II PW laser beam, and the highest cutoff energy of the proton beam was obviously increased. Accordingly, a double-film target structure was used, and the maximum cutoff energy of the proton beam was up to 70 MeV. These results demonstrate that the comprehensive performance of the SG-II PW laser facility was improved significantly.
As a typical plasma-based optical element that can sustain ultra-high light intensity, plasma density gratings driven by intense laser pulses have been extensively studied for wide applications. Here, we show that the plasma density grating driven by two intersecting driver laser pulses is not only nonuniform in space but also varies over time. Consequently, the probe laser pulse that passes through such a dynamic plasma density grating will be depolarized, that is, its polarization becomes spatially and temporally variable. More importantly, the laser depolarization may spontaneously take place for crossed laser beams if their polarization angles are arranged properly. The laser depolarization by a dynamic plasma density grating may find application in mitigating parametric instabilities in laser-driven inertial confinement fusion.
There is mixed evidence regarding the direction of a potential association between post-traumatic stress disorder (PTSD) and suicide mortality.
Aims
This is the first population-based study to account for both PTSD diagnosis and PTSD symptom severity simultaneously in the examination of suicide mortality.
Method
Retrospective study that included all US Department of Veterans Affairs (VA) patients with a PTSD diagnosis and at least one symptom severity assessment using the PTSD Checklist (PCL) between 1 October 1999 and 31 December 2018 (n = 754 197). We performed multivariable proportional hazards regression models using exposure groups defined by level of PTSD symptom severity to estimate suicide mortality rates. For patients with multiple PCL scores, we performed additional models using exposure groups defined by level of change in PTSD symptom severity. We assessed suicide mortality using the VA/Department of Defense Mortality Data Repository.
Results
Any level of PTSD symptoms above the minimum threshold for symptomatic remission (i.e. PCL score >18) was associated with double the suicide mortality rate at 1 month after assessment. This relationship decreased over time but patients with moderate to high symptoms continued to have elevated suicide rates. Worsening PTSD symptoms were associated with a 25% higher long-term suicide mortality rate. Among patients with improved PTSD symptoms, those with symptomatic remission had a substantial and sustained reduction in the suicide rate compared with those without symptomatic remission (HR = 0.56; 95% CI 0.37–0.88).
Conclusions
Ameliorating PTSD can reduce risk of suicide mortality, but patients must achieve symptomatic remission to attain this benefit.
Based on erosion coupon tests, a sand erosion model for 17-4PH steel was developed. The developed erosion model was validated against the results of compressor erosion tests from a generic rig and from other researchers. A high-fidelity computational fluid dynamics (CFD) model of the test rig was built, a user-defined function was developed to implement the erosion model into the ANSYS CFD software, and the turbulent, two-phase flow-field in multiple reference frames was solved. The simulation results are consistent with the test results from the compressor rig and with experimental findings from other researchers. Specifically, the sand erosion blunts the leading edge, sharpens the trailing edge and increases pressure-surface roughness. The comparisons between the experimental observations and numerical results as well as a quantitative comparison with three other sand erosion models indicate that the developed sand erosion model is adequate for erosion prediction of engine components made of 17-4PH steel.
American Indian and Alaska Native peoples (AI/AN) have a disproportionately high rate of obesity, but little is known about the social determinants of obesity among older AI/AN. Thus, our study assessed social determinants of obesity in AI/AN aged ≥ 50 years.
Design:
We conducted a cross-sectional analysis using multivariate generalised linear mixed models to identify social determinants associated with the risk of being classified as obese (BMI ≥ 30·0 kg/m2). Analyses were conducted for the total study population and stratified by median county poverty level.
Setting:
Indian Health Service (IHS) data for AI/AN who used IHS services in FY2013.
Participants:
Totally, 27 696 AI/AN aged ≥ 50 years without diabetes.
Results:
Mean BMI was 29·8 ± 6·6 with 43 % classified as obese. Women were more likely to be obese than men, and younger ages were associated with higher obesity risk. While having Medicaid coverage was associated with lower odds of obesity, private health insurance was associated with higher odds. Living in areas with lower rates of educational attainment and longer drive times to primary care services were associated with higher odds of obesity. Those who lived in a county where a larger percentage of people had low access to a grocery store were significantly less likely to be obese.
Conclusions:
Our findings contribute to the understanding of social determinants of obesity among older AI/AN and highlight the need to investigate AI/AN obesity, including longitudinal studies with a life course perspective to further examine social determinants of obesity in older AI/AN.
The long-distance stable transport of relativistic electron beams (REBs) in plasmas is studied by full three-dimensional particle-in-cell simulations. Theoretical analysis shows that the beam transport is mainly influenced by three transverse instabilities, where the excitation of self-modulation instability, and the suppression of the filamentation instability and the hosing instability are important to realize the beam stable transport. By modulating the transport parameters such as the electron density ratio, the relativistic Lorentz factor, the beam envelopes and the density profiles, the relativistic bunches having a smooth density profile and a length of several plasma wave periods can suppress the beam-plasma instabilities and propagate in plasmas for long distances with small energy losses. The results provide a reference for the research of long-distance and stable transport of REBs, and would be helpful for new particle beam diagnosis technology and space active experiments.
A practical method to evaluate quantitatively the uniformity of fuel/air mixing is essential for research and development of advanced low-emission combustion systems. Typically, this is characterised by measuring an unmixedness parameter or a uniformity index. An alternative approach, based on the fuel/air equivalence ratio distribution, is proposed and demonstrated in a simple methane/air venturi mixer. This approach has two main advantages: it is correlated with the fuel/air mixture combustion temperature, and the maximum temperature variation caused by fuel/air non-uniformity can be estimated. Because of these, it can be used as a criterion to check fuel/air mixing quality, or as a target for fuel/air mixer design with acceptable maximum temperature variation. For the situations where the fuel/air distribution non-uniqueness issue becomes important for fuel/air mixing check or mixer design, an additional statistical supplementary criterion should also be used.
Olanzapine effectively treats schizophrenia and bipolar I disorder (BD-I); however, its use is hindered by significant weight gain. A combination of olanzapine and samidorphan (OLZ/SAM) is in development to provide the efficacy of olanzapine while mitigating olanzapine-associated weight gain through opioid-receptor blockade. Here, we summarize OLZ/SAM clinical data.
Methods
The OLZ/SAM development program consists of 18 phase 1–3 clinical studies evaluating antipsychotic and weight mitigation efficacy of OLZ/SAM, along with pharmacokinetics, safety, and tolerability. Safety evaluation also included metabolic laboratory assessments.
Results
OLZ/SAM significantly improved psychotic symptoms (measured by Positive and Negative Syndrome Scale); improvements were similar to that observed with olanzapine vs placebo. OLZ/SAM resulted in significantly less weight gain than olanzapine. Additionally, 2 long-term phase 3 extension studies confirmed the durability of antipsychotic effect, as well as stabilization of weight and metabolic parameters in those continuing treatment. Supporting the potential use of OLZ/SAM in BD-I, OLZ/SAM or olanzapine resulted in bioequivalent olanzapine plasma concentrations, and OLZ/SAM did not affect lithium or valproate pharmacokinetics. OLZ/SAM treatment had no clinically relevant effects on ECG parameters (including QTc interval). OLZ/SAM and olanzapine safety were similar, except for reduced weight gain with OLZ/SAM; no additional safety risks were identified.
Conclusion
Data across 18 OLZ/SAM studies in >1600 subjects support an antipsychotic efficacy and safety profile for OLZ/SAM that is similar to olanzapine, with significantly less weight gain than olanzapine. OLZ/SAM is a potential new treatment for schizophrenia and BD-I patients needing efficacious long-term treatment with reduced risk of weight gain.
Efficient photosynthesis requires a balance of ATP and NADPH production/consumption in chloroplasts, and the exportation of reducing equivalents from chloroplasts is important for balancing stromal ATP/NADPH ratio. Here, we showed that the overexpression of purple acid phosphatase 2 on the outer membranes of chloroplasts and mitochondria can streamline the production and consumption of reducing equivalents in these two organelles, respectively. A higher capacity of consumption of reducing equivalents in mitochondria can indirectly help chloroplasts to balance the ATP/NADPH ratio in stroma and recycle NADP+, the electron acceptors of the linear electron flow (LEF). A higher rate of ATP and NADPH production from the LEF, a higher capacity of carbon fixation by the Calvin–Benson–Bassham (CBB) cycle and a greater consumption of NADH in mitochondria enhance photosynthesis in the chloroplasts, ATP production in the mitochondria and sucrose synthesis in the cytosol and eventually boost plant growth and seed yields in the overexpression lines.